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Recurrent massive pulmonary embolism following catheter directed thrombolysis in a 21-year-old with COVID-19: a case

Julian H Hirschbaum1,2, C Pierce Bradley2, Philip Kingsford2

  • 1Department of Pediatrics, Keck School of Medicine of USC, LAC+USC Med+Peds, IRD Building 2020 Zonal Avenue, Rm 115, Los Angeles, CA 90033, USA.

European Heart Journal. Case Reports
|July 16, 2021
PubMed

Insights

This case study details a young, otherwise healthy male who developed massive pulmonary embolism (PE) and recurrent PE following Coronavirus Disease-2019 (COVID-19). Treatment involved catheter-directed thrombolysis and ECMO, highlighting COVID-19

Area of Science:

  • Cardiology
  • Pulmonology
  • Infectious Diseases

Background:

  • Coronavirus Disease-2019 (COVID-19) is linked to a higher risk of pulmonary embolism (PE).
  • Venous thrombo-embolic (VTE) events can occur even in low-risk individuals with COVID-19.

Observation:

  • A 21-year-old male with no prior medical history presented with symptoms of COVID-19 and massive PE.
  • The patient experienced recurrent massive PE, acute respiratory failure, and hypotension shortly after initial treatment.
  • He required repeat catheter-directed thrombolysis (CDT) and extracorporeal membrane oxygenation (ECMO) for recovery.

Findings:

  • Despite extensive testing, no hypercoagulable risk factors were identified apart from COVID-19.
  • This case represents the youngest patient reported with massive PE secondary to COVID-19.
  • Successful treatment involved CDT and ECMO, facilitating right ventricular recovery.

Implications:

  • SARS-CoV-2 infection poses a significant thrombogenic risk, leading to severe complications even in young individuals.
  • Catheter-directed thrombolysis and ECMO are viable treatment options for massive PE in COVID-19 patients.
  • This case underscores the critical need for vigilance regarding VTE in COVID-19 patients, regardless of age or traditional risk factors.
Abstract

Keywords:
COVID-19COVID-19 associated hypercoagulabilityCase reportCatheter-directed thrombolysisECMOMassive pulmonary embolismPulmonary embolism

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